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Referrals to pediatric specialties are seldom completed, at least in underserved communities


Almost one-third of children from low-income communities who were referred to a specialist failed to complete the referral.


Almost one-third of children from low-income communities who were referred to a specialist failed to complete the referral.

Using electronic health records, completion within 60 days of referrals from 2 community health centers to any of 19 pediatric specialties was assessed in 577 children younger than 18 years. The 2 health care centers were located in underserved communities with large immigrant populations in Massachusetts.

As reported in the Journal of Pediatrics, 30.2% of the children did not complete the referral, with no significant difference between health care centers. Several patient-related and health care system factors were associated with incomplete referral:
• Older age of child;
• Lack of chronic health conditions;
• Public insurance status;
• Referral to a surgical specialty (vs other specialties);
• Low-volume specialty clinic;
• Wait times longer than 60 days for a first appointment;
• Appointment rescheduling within 60 days.

There was no correlation between race/ethnicity and language and incomplete referral.

The researchers noted that 100% referral completion “is likely neither feasible nor desirable,” and that resolution of health symptoms may explain why some of the referrals were not completed. They recommend investigating the effect of insurance denial and paperwork burden on referral completion.

Zuckerman KE, Cai X, Perrin JM, Donelan K. Incomplete specialty referral among children in community health centers. J Pediatr. 2011;158(1):24-30.

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